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Medicare Hospice Billing Updates: from CGS
Utah Hospice & Palliative Care Organization Sandy, UT| November 7, 2017 Nykesha Scales, MBA Utah Hospice & Palliative Care Organization Sandy, UT| November 3, 2015 Nykesha Scales November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Recent Change Requests & Hospice News
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Provider Enrollment Revalidation – Cycle 2
Revised, SE1605, Learning-Network-MLN/MLNMattersArticles/Downloads/SE1605.pdf Resumes regular revalidation cycles Implements several revalidation improvements Does not change other aspects of enrollment process Provides web link to check for revalidation due date & further instructions, November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Provider Enrollment Revalidation Web page
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Provider Enrollment/Revalidation Reminders & Tips
Only submit revalidation when due date is displayed When submitting revalidation via PECOS Web, ensure reason selected in PECOS is ‘Revalidation’ If ‘Change of Information’ is selected instead, could face payment withholds Consider electronically signing applications November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Provider Enrollment Top Development Reasons for September 2017
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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CGS Provider Enrollment Application Status
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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NEW: HH&H Provider Enrollment Interactive Help Tool
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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NOE Timely Filing & Exceptional Circumstance Guidelines QRT
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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SE17014: Required Workaround for Hospices Submitting Routine Home Care (RHC) & Service Intensity Add-On (SIA) Payments at the End of Life MLN/MLNMattersArticles/Downloads/SE17014.pdf Special Edition (SE) article corrects two errors with regard to hospice payments by Medicare that could result in overpayments. Also provides hospices with a workaround to deploy when submitting certain claims to ensure proper payment. Implementation Date: August 21, 2017 Effective Date: August 21, 2017 SE17029/Process for Hospices to Submit a List of Claims, MLN/MLNMattersArticles/downloads/SE17029.pdf November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements
Hospices to Get 1% Medicare Increase in FY2018 Cap amount for FY 2018 =$28, (2017 cap amount of $28, increased by 1 percent) Finalizes 8 measures from CAHPS Hospice Survey data already submitted by hospices Finalizes extension or exception for quality reporting purposes from 30 calendar days to 90 calendar days after date that an extraordinary circumstance occurred CMS began public reporting hospice quality reporting program (HQRP) data via Hospice Compare Site in August 2017 to help consumers make informed choices Discusses future considerations regarding Hospice Evaluation & Assessment Reporting Tool (HEART) Regulations effective October 1, 2017 November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements
Final Rule: pdf Change Request 10131: Guidance/Guidance/Transmittals/2017Downloads/R3828CP.pdf MM10131, Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for FY 2018: Education/Medicare-Learning-Network- MLN/MLNMattersArticles/downloads/MM10131.pdf November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Hospice Payment Rates November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Hospice Payment Rates Calculator
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Hospice Payment Rates Calculator
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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CR 10064: Accepting Hospice Notices of Election via Electronic Data Interchange (EDI)
Guidance/Guidance/Transmittals/2017Downloads/R3813CP.pdf Medicare contractors and hospices may develop trading partner agreements to exchange NOE and related transaction data using a non-standard implementation of the 837I transaction. Medicare will develop a companion guide for NOE transmissions. This guide will provide hospices instructions for how to complete data elements that are required by the 837I transaction but are not required by an NOE. Hospices may voluntarily agree to adopt the companion guide and submit non-standard 837I transactions. Implementation Date: January 1, 2018 Transactions received on/after January 1, 2018 Effective Date: January 2, 2018 November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Now Available: 2018 ICD-10 and GEMs
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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CMS Hospice Quality Reporting Web Page
Instruments/Hospice-Quality-Reporting/index.html November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Future Changes November 7, 2017
© 2017 Copyright, CGS Administrators, LLC.
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Future Changes? Future changes communicated by CMS via Change Requests (CRs) Providers can monitor CMS Hospice Center Web page, Type/Hospice-Center.html Sign up for CMS ListServs, Network-MLN/MLNProducts/downloads/MailingLists_FactSheet.pdf CMS Quarterly Provider Updates Web page, Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/index.html CMS Quarterly Provider Updates Updates, Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/CMS-Quarterly-Provider-Updates- -Updates.html CGS will communicate any final instructions via usual channels Home Health & Hospice Medicare Bulletin, CGS Listserv Join/update ListServ “Recent News” link, Provider education events, posted to Calendar of Events Web page, November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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New Medicare Card Project
We Need Your Help! November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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New Medicare Cards Known before as Social Security Number Removal Initiative (SSNRI) Under current system, several business partners use HICN to process Medicare transactions Under the new system, each person enrolled in Medicare will: be assigned a new MBI be mailed a new Medicare card MBI is confidential like the SSN and should be protected as Personally Identifiable Information November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Background Health Insurance Claim Number (HICN) is a Medicare beneficiary’s identification number, used for processing claims and determining eligibility for services across multiple entities (for example, Social Security Administration (SSA), Railroad Retirement Board (RRB), States, Medicare providers, and health plans) Medicare Access and CHIP Reauthorization Act (MACRA) of mandates removal of the Social Security Number (SSN)-based HICN from Medicare cards to address current risk of beneficiary medical identity theft Legislation requires that CMS mail out new Medicare cards with a new Medicare Number (also referred to as Medicare Beneficiary Identifier – (MBI)) by April 2019 New Medicare numbers won’t change Medicare benefits People with Medicare may start using their new Medicare cards as soon as they get them The Health Insurance Claim Number (HICN) is a Medicare beneficiary’s identification number, used for processing claims and for determining eligibility for services across multiple entities (for example, Social Security Administration (SSA), Railroad Retirement Board (RRB), States, Medicare providers, and health plans). The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 mandates the removal of the Social Security Number (SSN)-based HICN from Medicare cards to address current risk of beneficiary medical identity theft. The legislation requires that CMS mail out new Medicare cards with a new Medicare Number (also referred to as Medicare Beneficiary Identifier (MBI)) by April 2019. The new Medicare numbers won’t change Medicare benefits. People with Medicare may start using their new Medicare cards as soon as they get them. November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Operational Goals Primary Operational Goal: Decrease Medicare Beneficiary vulnerability to identity theft by removing the SSN-based number from their Medicare identification cards and replace with a new unique Medicare Number In achieving this goal, CMS seeks to Minimize burdens for beneficiaries Minimize burdens for providers Minimize disruption to Medicare operations Provide a solution to our business partners that allows usage of HICN and/or new Medicare Number for business critical data exchanges Manage the cost, scope, and schedule for the project Primary Operational Goal: To decrease Medicare beneficiary vulnerability to identity theft by removing the SSN-based number from their Medicare identification cards and replace with a new unique Medicare Number. In achieving this goal, the Centers for Medicare & Medicaid Services (CMS) seeks to Minimize burdens for beneficiaries Minimize burdens for providers Minimize disruption to Medicare operations Provide a solution to our business partners that allows usage of the Health Insurance Claim Number (HICN) and/or new Medicare Number for business critical data exchanges Manage the cost, scope, and schedule for the project November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Operations: 3 Steps to New Medicare Numbers
Generate new, unique Medicare Numbers for all people with Medicare: Includes existing (currently active, deceased, or archived) and people new-to-Medicare Issue new, redesigned Medicare cards: New cards containing the new Medicare Number to existing and new people with Medicare Modify systems and business processes: Required updates to accommodate receipt, transmission, display, and processing of the new Medicare Number CMS will use a number Medicare Beneficiary Identification (MBI) number generator to Assign 150 million MBIs in the initial enumeration (60 million active and 90 million deceased/archived) and generate a unique MBI for each new Medicare beneficiary. Issue new, redesigned Medicare cards: New cards containing the new Medicare Number to existing and new people with Medicare Modify systems and business processes: Required updates to accommodate receipt, transmission, display, and processing of the new Medicare Number November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Operations: HICN vs MBI
Health Insurance Claim Number (HICN) Primary Beneficiary Account Holder Social Security Number (SSN) plus Beneficiary Identification Code (BIC) 9-byte SSN plus 1 or 2-byte BIC Key positions 1-9 are numeric Medicare Beneficiary Identifier (MBI) New Non-Intelligent Unique Identifier 11 bytes Key positions 2, 5, 8, and 9 will always be alphabetic CMS anticipates that the MBI won’t be changed for an individual unless the MBI is compromised. November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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OLD Medicare Card vs NEW Medicare Card
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Operations: Transition Period
Transition period will run from April 1, 2018 through December 31, 2019 CMS will complete its system and process updates to be ready to accept and return the new Medicare Number on April 1, 2018 All stakeholders who submit or receive transactions containing the HICN must modify their processes and systems to be ready to submit or exchange the new Medicare Number by April 1, Stakeholders may submit either the new Number or HICN during the transition period CMS will accept, use for processing, and return to stakeholders either the new Medicare Number or HICN, whichever is submitted on the claim, during the transition period The transition period will run from April 1, 2018, through December 31, CMS will complete its system and process updates to be ready to accept and return the new Medicare Number on April 1, 2018. All stakeholders who submit or receive transactions containing the Health Insurance Claim Number (HICN) must modify their processes and systems to be ready to submit or exchange the new Medicare Number by April 1, Stakeholders may submit either the new Number or HICN during the transition period. CMS will accept, use for processing, and return to stakeholders either the new Medicare Number or HICN, whichever is submitted on the claim, during the transition period. November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Operations: Transition Period (continued)
Medicaid and supplemental insurers State Medicaid Agencies and supplemental insurers will be provided the new Medicare Numbers for Medicaid- eligible people who also have Medicare before new Medicare cards are mailed During the transition period, Medicare crossover claims will process and transmit with either the current HICN or new number Railroad Retirement Board (RRB) beneficiaries RRB will continue to send cards with the RRB logo, but you can’t tell from looking at the new Medicare Number if it’s for an RRB beneficiary Medicare Providers must program their systems to identify Railroad Retirement Board (RRB) beneficiaries so they know to send those claims to the Specialty Medicare Administrative Contractor (SMAC). Private payers For non-Medicare business, private payers won’t have to use the Medicare beneficiary identification number (MBI). We’ll continue to use supplemental insurer’s unique numbers to identify customers, but after the transition period, supplemental insurers must use the MBI for any Medicare transactions where they would have used the HICN. November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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MBI Generation and Transition Period
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Current Outreach Focus: Supporting Providers
Providers are implementing system changes to support the new Medicare number How CMS and MACs are supporting this: General information and guidance Developing a secure look-up tool for providers (to find new number at the point- of-service) Message on the HIPAA Eligibility Transaction System (HETS) to tell if a beneficiary’s new Medicare card was mailed In addition, CMS is working to develop capabilities where providers will be able to access a beneficiary’s Medicare beneficiary identification number (MBI) through a secure look-up tool at the point-of-service In instances in which a beneficiary does not have a new Medicare card at a provider’s office, we believe this look up tool will give providers a mechanism to access a beneficiary’s MBI securely without disrupting workflow. CMS is making systems changes so that when a provider checks a beneficiary’s eligibility, the CMS HIPAA Eligibility Transaction System (HETS) will return a message on the response indicating that CMS mailed that particular beneficiary’s new Medicare card. November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Outreach to People with Medicare
This is where we really need YOU! November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Messaging That Works Read the text in the table. November 7, 2017
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Messaging that Works (Continued)
Read the text in the table. November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Messaging That Works (Continued)
Other key points to reinforce…. Understand that mailing everyone a new card will take some time Card might arrive at a different time than their friend’s or neighbor’s Make sure beneficiary’s mailing address is up-to-date If address needs to be corrected, contact Social Security at ssa.gov/myaccount or (TTY: ) Beneficiaries should beware of anyone who contacts them about their new Medicare card Will never be asked to provide personal or private information to get new Medicare number and card Other key points to reinforce Understand that mailing everyone a new card will take some time. Your card might arrive at a different time than your friend’s or neighbor’s. Make sure your mailing address is up-to-date. If your address needs to be corrected, contact Social Security at ssa.gov/myaccount or TTY: Beware of anyone who contacts you about your new Medicare card. We will never ask you to give us personal or private information to get your new Medicare number and card. November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Sending New Medicare Cards
New cards start mailing in April 2018 and all cards are replaced by April 2019 deadline Gender and signature line won’t appear on new Medicare cards Once their card is mailed, someone with Medicare also may access their New Medicare Number on a Medicare Summary Notice or through MyMedicare.gov The Railroad Retirement Board will issue new cards to RRB beneficiaries New cards start mailing in April 2018, and all cards are replaced by April 2019 deadline. The gender and signature line won’t appear on new Medicare cards. Once mailed, someone with Medicare also can access their New Medicare Number on a Medicare Summary Notice or through MyMedicare.gov. The Railroad Retirement Board will issue new cards to RRB beneficiaries. November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Medicare Fee-For-Service provider Letters
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Medicare Fee-For-Service provider Letters
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Transition to New Medicare Numbers and Cards MLN Fact Sheet
MLN/MLNProducts/Downloads/TransitiontoNewMedicareNumbersandCards pdf November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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How to be Prepared Subscribe to the weekly MLN Connects newsletter for updates and new information, Attend training events Verify your patients’ addresses: If address you have on file is different than address you get in electronic eligibility transaction responses, ask your patients to contact Social Security and update their Medicare records Inform patients new cards will be issued in 2018 Get ready to use the new MBI Format: Ask your billing and office staff if your system can accept the 11 digit alpha numeric MBI If you use vendors to bill Medicare, ask them about their MBI practice management system changes and make sure they are ready for the change For updates: and/or November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Stay Connected Find more technical information, detailed updates, training opportunities, and materials to share on the web: Comments and questions are always welcome! Send to: November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Claim Submission Errors (CSEs)
Top Billing Errors Claim Submission Errors (CSEs) November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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CGS Claims Data – Hospice
September 2016– August 2017 Number of “Claims” Submitted 995,121 Total # of “Claim” Submission Errors (CSEs) 203,620 Hospice CSE Error Rate 20.46 November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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CGS Billing Errors – Hospice
September 2016 – August 2017 Reason Code Billing Error # of Errors 37402 Hospice sequential billing error 21,843 38200 Duplicate claim 13,799 U5194 Hospice claim rec'd for untimely NOE & OSC 77 is missing or invalid 9,659 U5106 Notice of election (NOE) falls within current hospice election 9,360 34952 SVC facility NPI not included 8,776 November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Top 5 Utah Hospice CSEs October 2016– September 2017 37402
Reason Code Billing Error # of Errors 37402 Hospice sequential billing error 1302 36458 Invalid CBSA 886 34952 SVC facility NPI not included 795 U5181 Occurrence code 27 required when certification date falls within dates of service 749 38200 Duplicate claim 697 November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Hospice Sequential Billing reminder: Reason Code 37402
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Hospice Sequential Billing Web page
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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myCGS & Web Resources 49 November 7, 2017
© 2017 Copyright, CGS Administrators, LLC.
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CGS HH&H Website: myCGS Portal http://www. cgsmedicare
myCGS: Login, FAQs, User Manual, Help Desk No costs associated with access to myCGS November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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What Can myCGS Do For My Agency?
Use myCGS to do all of this & more… Submit Quarterly Credit Balance Reports Submit Cost Reports Respond to Medical Review (MR) Additional Documentation Requests (ADRs) Submit Requests for Redeterminations (including attachments) Upload attachments to your myCGS redetermination requests up to 40MBs in size (not to exceed a total attachment size of 150MBs) November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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What Can myCGS Do For My Agency?
View & Print Copies of Remittance Advices Check Patient Eligibility 24/7 Request an “immediate offset” of a demanded overpayment (eOffset) View Number of Claims Approved for Payment & Approved Amounts Submit general inquiries via myCGS Register TODAY, November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Forms Tab Allows Providers to:
Submit Certain Forms Directly to CMS via myCGS Web Portal Redeterminations & e-Offsets Respond to Medical Review (MR) Additional Development Requests (ADRs) Report Credit Balances (CMS-838 Report) Submit Cost Reports November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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myCGS Help?? Who Do I Call?? myCGS Registration Checklist, myCGS Help Desk, Supported by CGS Electronic Data Interchange (EDI) staff (Option 2) November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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CMS Website http://www.cms.gov
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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CMS Resources Internet-Only Manuals (IOMs) Transmittals
Medicare Benefit Policy Manual Hospice/Publication , Ch. 9 Medicare Claims Processing Manual Hospice/Publication , Ch. 11 Transmittals Change Requests (CRs) Medicare Learning Network (MLN) MLN Articles Educational Products National Provider Calls November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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CGS HH&H Website Join/Update ListServ
August 25, 2016 Join/Update ListServ Search engine Contact Us link November 7, 2017 © 2017 Copyright, CGS Administrators, LLC. CGS Administrators, LLC Home Health Billing - Part 1
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CGS HH&H Website http://www.cgsmedicare.com/hhh/index.html Quick Links
Main navigation menu Hot Topics November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Updated: HH&H Customer Service Web page
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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CGS HH&H Website: Claims http://www. cgsmedicare. com/hhh/claims/index
Claims: ADRs, Checking Claim Status, FAQs, FISS, MSP, Timely Filing, RTPs, ICD-10 November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Fiscal Intermediary Standard System Claims Processing Issues
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Updated: CGS HH&H Website: Education & Resources http://www
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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CGS HH&H Website: Educational Materials
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Hospice Quick Resource Tools
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Hospice Billing Code Sheet
November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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CGS HH&H Website: News & Publications http://www. cgsmedicare
News & Publications: Recent News (ListServs), CGS Bulletin, EDI Connection, Join ListServ November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Reminder: Join the ListServs
Sign up for CMS ListServs MLN/MLNProducts/downloads/MailingLists_FactSheet.pdf CGS ListServ Join/update ListServ November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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Questions?? CGS Provider Contact Center: 1.877.299.4500
Option 1: Customer Service Option 2: Electronic Data Interchange (EDI) Option 3: Provider Enrollment Option 4: Overpayment Recovery (OPR) Twitter: Facebook: November 7, 2017 © 2017 Copyright, CGS Administrators, LLC.
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